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NRSG 421 > Week 1 - Oxygenation > Flashcards

Week 1 - Oxygenation Flashcards

1
Q

What are the treatments for acidosis?

A
  • NaHCO3 PO/IV
  • polystyrene sulfonate
  • glucose and insulin
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2
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for NaHCO3?

A
  • renal impairment
  • CV disease
  • hypocalcemia
  • alkalosis
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3
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for polystyrene sultanate?

A
  • abnormal bowel functions
  • SE
  • constipation
  • fecal impaction
  • intestinal necrosis
  • N/V
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4
Q

in regards to the treatment of acidosis, what cautions do you need to take into consideration for glucose and insulin?

A

conditions/ current status

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5
Q

what are the S&S of acidosis?

A
  • CNS depression
  • hyperkalemia
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6
Q

what is the treatment for alkalosis?

A
  • ammonium chloride
  • KCl
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7
Q

in regards to the treatment of alkalosis, what cautions do you need to take into consideration for ammonium chloride?

A
  • liver disease
  • renal function
  • metabolic acidosis
  • Ca deficit
  • ammonium toxicity
  • vein irritation
  • rash
  • bradycardia
  • N/V
  • headache
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8
Q

what are the S&S of alkalosis?

A
  • CNS stimulation
  • hypokalemia
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9
Q

what conditions cause respiratory acidosis? why?

A
  • COPD
  • obesity
  • use of opioids

all cause hypoventilation that lead to CO2 retention

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10
Q

what conditions cause respiratory alkalosis? Why?

A
  • anxiety
  • pneumonia
  • PE

all increase the RR and decrease CO2

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11
Q

what causes metabolic acidosis?

A
  • DKA
  • aspirin
  • diarrhea
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12
Q

what conditions cause metabolic alkalosis? why?

A
  • emesis
  • NG suction
  • diuretics

all cause loss of acid (vomiting) or gain of a base

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13
Q

define COPD

A
  • systemic disease
  • largely manifesting as an airflow-obstructing respiratory disorder
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14
Q

what does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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15
Q

how can COPD manifest?

A
  • emphysema
  • asthma
  • bronchiectasis
  • cystic fibrosis
  • chronic bronchitis
  • AECOPD
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16
Q

in regards to the different ways COPD can manifest, describe emphysema

A

lung tissue destruction and abnormal permanent enlargement of lung acini

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17
Q

define acini

A

airspaces distal to terminal bronchioles

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18
Q

in regards to the different ways COPD can manifest, describe bronchiectasis

A
  • destruction and widening of large airways
  • results in hyper-secretion of mucus and recurrent infections
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19
Q

in regards to the different ways COPD can manifest, describe chronic bronchitis

A
  • productive cough for 3 months per year over 2 consecutive years
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20
Q

in regards to the different ways COPD can manifest, describe AECOPD

A

sustained changes (>48 hrs) in:
- dyspnea
- cough
- sputum production

require increased use of medications to manage

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21
Q

COPD normally occurs in who?

A
  • people 40 years or older with smoking history
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22
Q

what are the risk factors for COPD?

A
  • smoking
  • heredity
  • age
  • lung infections
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23
Q

the risk for COPD increases with what?

A

the number of pack-years and a history of more than 40 pack years

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24
Q

describe the pathophysiology of COPD

A
  • decreased elasticity of lungs
  • increased production of mucous/ inflammation in airways which block air flow
  • air becomes trapped during expiation
  • chronic stage results in barrel chest > makes it more difficult to breath
  • bull and blebs form > not effective in gas exchange/ lead to hypoxemia/ hypercapnia
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25
what are the signs of COPD?
- prolonged expiration - rapid/ shallow breathing - barrel chest - hoover's sign - dyspnea - expiratory wheeze - fatigue/ lower exercise tolerance - chronic cough with sputum - pursed-lip breathing - muscle weakness/ wasting - tripod sitting position - neck SCM
26
in regards to the signs of COPD, describe prolonged expiration
lung tissue damage may cause decreased elastic recoil to push air out of lungs
27
in regards to the signs of COPD, describeHoover's sign
- occurs in end stage when diaphragm is 'flat' and continued inspiratory efforts further contracts the diaphragm/ pulls the lower chest wall inwards
28
in regards to the signs of COPD, describe dyspnea
- caused by decreased lung expansion and airflow obstruction > causes lungs to work harder to breathe - manifests as SOB especially on exertion
29
in regards to the signs of COPD, describe fatigue/ lower exercise tolerance
- airflow obstruction leads to decreased alveoli ventilation - causes decreased 02 in blood > decreases the perfusion of tissues in the body
30
in regards to the signs of COPD, describe pursed-lip breathing
- occurs in end stage - airflow obstruction causes client to breathe out against mouth pressure - forcing airways to widen
31
in regards to the signs of COPD, describe muscle weakness/ wasting
- occurs in end stage - airflow obstruction causes chronic fatigue - leads to deconditioning
32
in regards to the signs of COPD, describe tripod sitting position
- occurs in end-stage - airflow obstruction causes pt to breathe with accessory muscles and diaphragm to improve airflow - uses pectoral muscles to aid breathing
33
in regards to the signs of COPD, describe neck SCM
- scalene muscle contraction - use of accessory muscles
34
what symptoms may the patient report for COPD?
- muscle weakness - morning cough - increased production of mucous/ sputum - breathlessness with exertion - fatigue
35
what diagnostics are used for COPD?
- spirometry - ABGs - CXR
36
in regards to the diagnostics for COPD describe spirometry
measures lung volume, capacities, the rate of flow, and gas exchange
37
what is included in primary assessments?
- ABCDE - find and correct all life threatening conditions
38
what is included in secondary interventions?
- FGHI - explore medical conditions
39
what does FGHI stand for
F - full VS G - give comfort H - history & HTT I - inspect posterior
40
what achronym do you use in trauma situations?
AMPLE
41
what does AMPLE stand for?
A - allergies M - medications P - past medical history L - last meal E - events
42
what are 3 priority teaching points for COPD?
- prevention - manage - action plan
43
in regards to the 3 priority teaching points for COPD what is included in prevention?
- vaccinations - quit smoking - avoid triggers
44
in regards to the 3 priority teaching points for COPD what is included in mangement?
- take meds as ordered - eat healthy - exercise as tolerated
45
in regards to the 3 priority teaching points for COPD what is included in action plan?
- exacerbation - infection - anxiety
46
describe hypoxic drive
- live in constant hypercapnia with constant CO2 - giving long term O2 can make symptoms worse/ cause them to move into resp. arrest - chronic state of hypercapnia/ resp. acidosis leads to hypoxic drive and ran off of low O2
47
what medications would you expect a person with COPD to have?
- albuterol - methylprednisolone - prednisone - moxifloxacin
48
describe albuterol
- rescue inhaler - used for exacerbations - bronchodilator
49
describe methylprednisolone
- long acting - daily use - can take IV, IM, PO
50
what is the preferred method of giving prednisone? can you stop it abruptly?
- oral route preferred - needs to be weened off
51
when is moxifloxacin used? what is it?
- antibiotic - bacterial infections - used for people with penicillin allergy - moderate AECOPD
52
in regards to V/Q mismatch, what does V stand for?
- ventilation - ability of lungs to inhale/ exhale or ventilate
53
in regards to V/Q mismatch, what does Q stand for?
- perfusion
54
what does V/Q mismatch mean?
- mismatch between 2 lungs - PE decreases perfusion and the BV are blocked = less circulation/ perfusion
55
what can V/Q mismatch cause?
- lack of perfusion to rest of body tissue - dead space > oxygen not able to reach part of lung
56
what are some clinical manifestations the nurse might see for a PE?
- sudden onset - confusion - SOB - chest pain - tachycardia - increased WOB - cough c bloody secretions - cyanosis - fainting - anxiety - hypotension
57
what are signs and symptoms of a DVT?
- pleuritic chest pain - dyspnea - tachycardia - tachypnea - hypoxemia - cough
58
why can a DVT not cause a stroke?
clot would have to move through right side of heart and then into lungs > would get caught in one of those organs and would not be able to make it to the brain
59
what are some risk factors for a PE?
- smoking - cancer - chemotherapy - sedentary lifestyle - trauma - surgery - hypercoagulability - estrogen - obesity - polycythemia
60
what cause a PE?
DVT in arm or leg
61
what are some risk factors/ causes of a stroke?
- PICC - A. Fib
62
why does estrogen put someone at an increased risk for a PE?
increases fibrin formation
63
describe pneumonia
lung infection due to exposure to fungi, bacteria or virus
64
what does pneumonia cause?
fluid build up that prevents proper lung expansion and oxygen to go into body
65
what is pulmonary shunting?
- fluid in alveoli that prevents oxygen from reaching underlying blood vessel - prevents gas exchange - decreased O2, increased CO2
66
what are 3 serious complications of pneumonia?
- ARDS - abscess - sepsis and shock
67
pneumonia can cause inflammation which could result in stiff lungs and decreased compliance. What else can it lead to?
- endocarditis - pericarditis - meningitis - bacteremia
68
define endocarditis
inflammation of the inner lining of the heart's chambers/ valves
69
define pericarditis
swelling/ irritation of tissue surrounding heart
70
define meningitis
inflammation of the tissues surrounding the brain and spinal cord
71
define bacteremia
presence of bacteria in bloodstream
72
what acronym do we use to remember the other complications of pneumonia ?
SLAP HER
73
what does the SLAP HER acronym stand for when talking about other complications of pneumonia ?
S - sepsis L - lung abscess A - ARDS P - parapneumonic effusion H - hypotension E - empyema/ effusion R - respiratory/ renal failure
74
what are early signs of respiratory failure?
- tachycardia - tachypnea - restlessness - confusion
75
what are late signs of respiratory failure?
- altered LOC - dysrhythmia - hypotension - cyanosis - ileus - N/V - ileus - N/V - decreased urinary output - renal failure
76
what are complications of an abscess?
- fistula - spread - bleeding - empyema
77
what are the signs someone has an abscess?
- bad breath - fever >38.3 - chest pain - SOB - night sweats
78
how can pneumonia result in sepsis/ shock?
bacteria enter blood stream and body is in inflammatory hyperdrive
79
when screening a pt for sepsis, what are the things you are looking for FIRST?
have 2 of the following: - HR > 90/min - RR > 20/min - temp > or = to 38 degrees or <36 - altered mental status/ GCS change - WBC > 12.0 or < 4.0x10/L
80
when screening a pt for sepsis, after determining they have 2 signs what are the things you are looking for SECOND?
confirmed/ suspected source of infection OR: - looks unwell - 65+ yrs old - recent surgery - immunocompromised - chronic illness
81
when screening a pt for sepsis, after you confirmed or figured out the pt has an infection or one of the other items what do you looking at next?
- SBP < 90 mmHg - MAP < 65 mmHg
82
what are key interventions you could do for a patient with sepsis?
- blood cultures before abx - abx w/in 3hrs - balance crystalloid - measure lactate within 3 hrs and repeat in 2-4hrs if elevated - norepinephrine if hypotensive after bolus - with significant ongoing vasopressor consider IV hydrocortisone
83
what would be some examples of nursing interventions you could apply for a client with COPD, pneumonia or PE?
- reposition - breathing exercises - O2 therapy - hydration - medication
84
what medications could you give to a client with COPD, pneumonia or PE?
- bronchodilators - corticosteroids - antibiotics - anti-mucolytics - vaccinations - antipyretics - analgesics - anticoagulants - diuretics - anti anxiety
85
what are some medications we may want to be cautious with providing for a client with reduced oxygenation?
- narcotics - benzodiazepines - barbiturates - cough suppressants
86
a client with reduced O2 of unknown cause. What are some diagnostics to find a respiratory cause or to rule out other causes?
- labs - diagnostics - invasive - cultures - others
87
when determining or trying to rule out cause for a pt with reduced oxygenation what labs would you be assessing?
- troponin - BNP - ABG - CBC - electrolytes - renal panel - INR/ PTT - CRP
88
when determining or trying to rule out cause for a pt with reduced oxygenation what diagnostics would you be assessing?
- CXR - CT - CT with contrast - VQ scan - MRI - ECG
89
when determining or trying to rule out cause for a pt with reduced oxygenation what invasive tests might be ordered?
- bronchoscopy - thoracentesis
90
when determining or trying to rule out cause for a pt with reduced oxygenation what cultures would you collect?
- NP swab - sputum C&S
91
when determining or trying to rule out cause for a pt with reduced oxygenation what other things might be done?
- VS - assessment - PFT - FEV - FVC - peak flow
92
what does stridor indicate?
- trachea blocked
93
what does bronchi indicate?
- fluid in bronchi/ trachea
94
where does a pleural effusion happen?
- in the all of the lungs - can use a chest tube for this

NRSG 421 (6 decks)

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